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Yeun YR, Kwak YS, Kim HY. Factors affecting weight management in overweight or obese diabetic patients: the 2018-2021 Korea national health and nutrition examination survey. Phys Act Nutr 2024; 28:24-30. [PMID: 38719463 PMCID: PMC11079378 DOI: 10.20463/pan.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE Diabetes is a chronic metabolic disease that affects approximately 422 million people worldwide and leads to the death of 1.5 million people every year. The prevalence of diabetes among the population aged 30 or older in Korea has steadily increased since 2018, reaching 16.7% in 2020, with one in six adults having diabetes. This study was conducted to identify factors affecting weight management in overweight or obese patients with diabetes (OOPD) in Korea using data from the 2018-2022 National Health and Nutrition Examination Survey. Therefore, the goal of this study is to analyze weight perception and factors related to weight perception and to identify factors that influence weight loss efforts among OOPD in Korea. METHODS Socioeconomic characteristics, disease morbidity, weight perception, and weight loss efforts were investigated in 950 participants. Data were analyzed using descriptive statistics, cross-tabulation, and logistic regression. RESULTS Among the overweight or obese patients with diabetes, 24.4% perceived their weight to be normal, with a higher proportion among men (29.6%) than among women (14.6%). Weight loss efforts were 5.11 times (95% CI: 3.02-8.66) higher in people with overweight perceptions than in those with normal weight perceptions. Additionally, the rate was 1.54 times (95% CI: 1.06 2.25) higher in people with dyslipidemia than in those without dyslipidemia. CONCLUSION These results suggest that weight management approaches for overweight or obese patients with diabetes should be designed individually based on weight perception and disease morbidity.
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Affiliation(s)
- Young-Ran Yeun
- Department of Nursing, Kangwon National University, Gangwondo, Republic of Korea
| | - Yi Sub Kwak
- DEU Exe-Physio Lab, Department of physical education, Dong-Eui University, Busan, Republic of Korea
| | - Hye-Young Kim
- Department of Hygiene, Kangwon National University, Gangwondo, Republic of Korea
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Park SH, Lee YB, Lee KN, Kim B, Cho SH, Kwon SY, Park J, Kim G, Jin SM, Hur KY, Han K, Kim JH. Risk of Depression according to Cumulative Exposure to a Low-Household Income Status in Individuals with Type 2 Diabetes Mellitus: A Nationwide Population- Based Study. Diabetes Metab J 2024; 48:290-301. [PMID: 38171143 PMCID: PMC10995483 DOI: 10.4093/dmj.2022.0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGRUOUND We aimed to identify the risk of incident depression according to cumulative exposure to a low-household income status in individuals with type 2 diabetes mellitus (T2DM). METHODS For this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2002 to 2018. Risk of depression was assessed according to cumulative exposure to low-household income status (defined as Medical Aid registration) during the previous 5 years among adults (aged ≥20 years) with T2DM and without baseline depression who underwent health examinations from 2009 to 2012 (n=2,027,317). RESULTS During an average 6.23 years of follow-up, 401,175 incident depression cases occurred. Advance in cumulative number of years registered for medical aid during the previous 5 years from baseline was associated with an increased risk of depression in a dose-dependent manner (hazard ratio [HR], 1.44 [95% confidence interval (CI), 1.38 to 1.50]; HR, 1.40 [95% CI, 1.35 to 1.46]; HR, 1.42, [95% CI, 1.37 to 1.48]; HR, 1.46, [95% CI, 1.40 to 1.53]; HR, 1.69, [95% CI, 1.63 to 1.74] in groups with 1 to 5 exposed years, respectively). Insulin users exposed for 5 years to a low-household income state had the highest risk of depression among groups categorized by insulin use and duration of low-household income status. CONCLUSION Cumulative duration of low-household income status, defined as medical aid registration, was associated with an increased risk of depression in a dose-response manner in individuals with T2DM.
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Affiliation(s)
- So Hee Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-na Lee
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bongsung Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - So Hyun Cho
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yoon Kwon
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiyun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
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Kim HK, Lee W, Ryu IH, Kim JK, Kim H, Yoo TK. Association between metformin use and the risk of developing open-angle glaucoma among patients with diabetes: a retrospective cohort study and meta-analysis. Int Ophthalmol 2024; 44:6. [PMID: 38316664 DOI: 10.1007/s10792-024-02945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE Recent studies examining the neuroprotective effects of metformin on open-angle glaucoma (OAG) have failed to provide consistent results. In this study, we investigated the association between metformin use and OAG. METHODS Data were obtained from a sample cohort of the Korean National Health Insurance database. Patients diagnosed with type-2 diabetes (T2DM) between 2004 and 2013 were included. We performed propensity score-matched analysis in a matched cohort (N = 20,646). The risk of the newly developed OAG was estimated using a Cox proportional hazards model. Including the present study, the meta-analysis included five studies to calculate the pooled risk for OAG based on metformin use. RESULTS In the adjusted model, the analysis revealed no statistical association between metformin use and OAG incidence (hazard ratio [HR] 1.05; 95% confidence interval [CI] 0.79-1.40; P = 0.738). The highest tercile of metformin use demonstrated no statistical significance (HR 0.93 [95% CI 0.63-1.37]; P = 0.703). No significant dose-dependent association was observed between the cumulative dose and incidence of OAG (P-value for trend = 0.336). In a meta-analysis of four published articles and the present study, the common-effects and random-effects models indicated conflicting results in terms of significance. The random effects model demonstrated no significant association (pooled risk ratio 0.53; 95% CI 0.24-1.19; P = 0.123). CONCLUSION We found no significant association between metformin use and OAG incidence in patients with T2DM in this population-based cohort study and meta-analysis. Further studies are needed to investigate the association between metformin use and the risk of OAG among patients with T2DM.
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Affiliation(s)
- Hong Kyu Kim
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Wanhyung Lee
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Ik Hee Ryu
- Department of Ophthalmology, B&VIIT Eye Center, Seoul, Republic of Korea
| | - Jin Kuk Kim
- Department of Ophthalmology, B&VIIT Eye Center, Seoul, Republic of Korea
| | | | - Tae Keun Yoo
- Department of Ophthalmology, B&VIIT Eye Center, Seoul, Republic of Korea.
- Department of Refractive Surgery; VISUWORKS, B&VIIT Eye Center, B2 GT Tower, 1317-23, Seocho-Dong, Seocho-Gu, Seoul, Republic of Korea.
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Kang P, Kim KY, Shin HY. Association between Dyslipidemia and Glycated Hemoglobin in a Population-Based Study. Metabolites 2024; 14:92. [PMID: 38392984 PMCID: PMC10890523 DOI: 10.3390/metabo14020092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
Diabetes mellitus and dyslipidemia are well-known risk factors for cardiovascular disease. Unfortunately, the prevalence of dyslipidemia and diabetes mellitus among individuals over 30 years of age in Korea has continuously increased. The current study therefore investigated the association between dyslipidemia and high glycated hemoglobin (Hemoglobin A1c, HbA1c) levels according to age group in adults over 20 years old. We used data from the 7th Korea National Health and Nutrition Examination Survey conducted by the Korea Centers for Disease Control and Prevention from 2016 to 2017. Glycated hemoglobin, a well-established marker for elevated glucose levels, was categorized into three groups, normal (<5.7%), prediabetes (5.7-6.4%), and diabetes (≥6.5%). The presence of dyslipidemia was defined based on a diagnosis of dyslipidemia by a physician. Logistic regression analyses were performed to evaluate the association between the prevalence of dyslipidemia and glycated hemoglobin according to age group. After adjusting for possible confounders, including age, sex, body mass index, marital status, education, occupation, household income, drinking, and smoking, we found a significant increase in the odds ratios (ORs) for dyslipidemia in the prediabetes (OR; 1.915, 95% CI; 1.696 to 2.163) and diabetes (OR; 3.533, 95% CI; 3.019 to 4.134) groups. Among subjects with higher glycated hemoglobin levels, those in their 40s or over had significantly increased odds for dyslipidemia. The current study found an association between high glycated hemoglobin levels and a diagnosis of dyslipidemia among Korean adults. Markers of lipid metabolism in adults with high glycated hemoglobin levels may need to be monitored, especially those in their 40s and older.
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Affiliation(s)
- Purum Kang
- College of Nursing, Woosuk University, Wanju 55338, Republic of Korea
| | - Ka Young Kim
- Department of Nursing, College of Nursing, Gachon University, Incheon 21936, Republic of Korea
| | - Hye Young Shin
- Department of Nursing, Gangseo University, Seoul 07661, Republic of Korea
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Lee YB, Kim H, Lee J, Kang D, Kim G, Jin SM, Kim JH, Jeon HJ, Hur KY. Psychotic Disorders and the Risk of Type 2 Diabetes Mellitus, Atherosclerotic Cardiovascular Diseases, and All-Cause Mortality: A Population-Based Matched Cohort Study. Diabetes Metab J 2024; 48:122-133. [PMID: 38173370 PMCID: PMC10850276 DOI: 10.4093/dmj.2022.0431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/27/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGRUOUND The effects of psychotic disorders on cardiometabolic diseases and premature death need to be determined in Asian populations. METHODS In this population-based matched cohort study, the Korean National Health Insurance Service database (2002 to 2018) was used. The risk of type 2 diabetes mellitus (T2DM), acute myocardial infarction (AMI), ischemic stroke, composite of all cardiometabolic diseases, and all-cause death during follow-up was compared between individuals with psychotic disorders treated with antipsychotics (n=48,162) and 1:1 matched controls without psychiatric disorders among adults without cardiometabolic diseases before or within 3 months after baseline. RESULTS In this cohort, 53,683 composite cases of all cardiometabolic diseases (during median 7.38 years), 899 AMI, and 1,216 ischemic stroke cases (during median 14.14 years), 7,686 T2DM cases (during median 13.26 years), and 7,092 deaths (during median 14.23 years) occurred. The risk of all outcomes was higher in subjects with psychotic disorders than matched controls (adjusted hazard ratios [95% confidence intervals]: 1.522 [1.446 to 1.602] for T2DM; 1.455 [1.251 to 1.693] for AMI; 1.568 [1.373 to 1.790] for ischemic stroke; 1.595 [1.565 to 1.626] for composite of all cardiometabolic diseases; and 2.747 [2.599 to 2.904] for all-cause mortality) during follow-up. Similar patterns of associations were maintained in subgroup analyses but more prominent in younger individuals (P for interaction <0.0001) when categorized as those aged 18-39, 40-64, or ≥65 years. CONCLUSION Patients with psychotic disorders treated with antipsychotics were associated with increased risk of premature allcause mortality and cardiometabolic outcomes in an Asian population. This relationship was more pronounced in younger individuals, especially aged 18 to 39 years.
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Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyewon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee YB, Park SH, Lee KN, Kim B, Kwon SY, Park J, Kim G, Jin SM, Hur KY, Han K, Kim JH. Low Household Income Status and Death from Pneumonia in People with Type 2 Diabetes Mellitus: A Nationwide Study. Diabetes Metab J 2023; 47:682-692. [PMID: 37349081 PMCID: PMC10555537 DOI: 10.4093/dmj.2022.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/17/2022] [Indexed: 06/24/2023] Open
Abstract
BACKGRUOUND We explored the risk of death from pneumonia according to cumulative duration in low household income state (LHIS) among adults with type 2 diabetes mellitus (T2DM). METHODS Using Korean National Health Insurance Service data (2002 to 2018), the hazards of mortality from pneumonia were analyzed according to duration in LHIS (being registered to Medical Aid) during the 5 years before baseline (0, 1-4, and 5 years) among adults with T2DM who underwent health examinations between 2009 and 2012 (n=2,503,581). Hazards of outcomes were also compared in six groups categorized by insulin use and duration in LHIS. RESULTS During a median 7.18 years, 12,245 deaths from pneumonia occurred. Individuals who had been exposed to LHIS had higher hazards of death from pneumonia in a dose-response manner (hazard ratio [HR], 1.726; 95% confidence interval [CI], 1.568 to 1.899 and HR, 4.686; 95% CI, 3.948 to 5.562 in those exposed for 1-4 and 5 years, respectively) compared to the non-exposed reference. Insulin users exposed for 5 years to LHIS exhibited the highest outcome hazard among six groups categorized by insulin use and duration in LHIS. CONCLUSION Among adults with T2DM, cumulative duration in LHIS may predict increased risks of mortality from pneumonia in a graded dose-response manner. Insulin users with the longest duration in LHIS might be the group most vulnerable to death from pneumonia among adults with T2DM.
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Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Hee Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-na Lee
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bongsung Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - So Yoon Kwon
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiyun Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
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Association of general and central obesity, and their changes with risk of knee osteoarthritis: a nationwide population-based cohort study. Sci Rep 2023; 13:3796. [PMID: 36882508 PMCID: PMC9992488 DOI: 10.1038/s41598-023-30727-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
In this study, we aimed to evaluate the association between general and central obesity, and their changes with risk of knee osteoarthritis (OA) using retrospective cohort data collected from the Korean National Health Insurance Service. We studied 1,139,463 people aged 50 and over who received a health examination in 2009. To evaluate the association between general and/or central obesity and knee OA risk, a Cox proportional hazard models were used. Additionally, we investigate knee OA risk according to the change in obesity status over 2 years for subjects who had undergone health examinations for 2 consecutive years. General obesity without central obesity (HR 1.281, 95% CI 1.270-1.292) and central obesity without general obesity (HR 1.167, 95% CI 1.150-1.184) were associated with increased knee OA risk than the comparison group. Individuals with both general with central obesity had the highest risk (HR 1.418, 95% CI 1.406-1.429). This association was more pronounced in women and younger age group. Remarkably, the remission of general or central obesity over two years was associated with decreased knee OA risk (HR 0.884; 95% CI 0.867-0.902; HR 0.900; 95% CI 0.884-0.916, respectively). The present study found that both general and central obesity were associated with increased risk of knee OA and the risk was highest when the two types of obesity were accompanied. Changes in obesity status have been confirmed to alter the risk of knee OA.
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Koo DH, Han K, Park CY. Impact of cumulative hyperglycemic burden on the pancreatic cancer risk: A nationwide cohort study. Diabetes Res Clin Pract 2023; 195:110208. [PMID: 36513269 DOI: 10.1016/j.diabres.2022.110208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
AIMS We aimed to investigate how much cumulative hyperglycemia exposure increases pancreatic cancer risk. METHODS This study used the National Health Insurance Service Database of Claims and included 3,138,099 individuals who underwent four consecutive annual health screenings between 2009 and 2013. We defined hyperglycemic burden in two ways. First, the hyperglycemic burden was given a score from 0 to 4, with one point assigned for each time blood glucose was ≥100 mg/dL or the use of an antidiabetic drug. Furthermore, we performed semiquantitative scoring of a pre-diabetic (100-125; 1 point) and diabetic level (≥126; 2 points) and categorized into one of nine groups (hyperglycemic score 0-8). RESULTS During the median 6.2 years of follow-up, groups with a hyperglycemic burden of 1, 2, 3, and 4 had a 15%, 30%, 26%, and 67% increased pancreatic cancer risk compared with normal subjects. In semiquantitative analyses, individuals with a pre-diabetic glucose level on at least one occasion had a 14% increased the risk. Furthermore, individuals with a burden score of 8 had an 89% higher risk than subjects with a normal range. CONCLUSIONS The pancreatic cancer incidence increased significantly according to the hyperglycemic burden, defined as sustained hyperglycemic exposure, including pre-diabetic levels.
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Affiliation(s)
- Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Fasting blood glucose and risk of incident pancreatic cancer. PLoS One 2022; 17:e0274195. [PMID: 36301855 PMCID: PMC9612540 DOI: 10.1371/journal.pone.0274195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 08/23/2022] [Indexed: 11/07/2022] Open
Abstract
Background The number of patients with diabetes and impaired fasting blood glucose in Korea is rapidly increasing compared to the past, and other metabolic indicators of population are also changed in recent years. To clarify the mechanism more clearly, we investigated the association between fasting blood glucose and incidence of pancreatic cancer in this retrospective cohort study. Methods In Korea National Health Information Database, 19,050 participants without pancreatic cancer in 2009 were enrolled, and followed up until 2013. We assessed the risk of incident pancreatic cancer according to the quartile groups of fasting blood glucose level (quartile 1: <88 mg/dL, quartile 2: 88–97 mg/dL, quartile 3: 97–109 mg/dL and quartile 4: ≥109 mg/dL). Multivariate Cox-proportional hazard model was used in calculating hazard ratios (HRs) and 95% confidence interval (CI) for incident pancreatic cancer. Results Compared with quartile1 (reference), unadjusted HRs and 95% CI for incident pancreatic cancer significantly increased in order of quartile2 (1.39 [1.01–1.92]), quartile3 (1.50 [1.09–2.07]) and quartile4 (2.18 [1.62–2.95]), and fully adjusted HRs and 95% CI significantly increased from quartile2 (1.47 [1.05–2.04]), quartile3 (1.61 [1.05–2.04]) to quartile4 (2.31 [1.68–3.17]). Conclusion Fasting blood glucose even with pre-diabetic range was significantly associated with the incident pancreatic cancer in Korean.
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Bae EH, Lim SY, Yang EM, Oh TR, Choi HS, Kim CS, Ma SK, Kim B, Han KD, Kim SW. Low waist circumference prior to percutaneous coronary intervention predict the risk for end-stage renal disease: a nationwide Korean population based-cohort study. Korean J Intern Med 2022; 37:639-652. [PMID: 35143719 PMCID: PMC9082428 DOI: 10.3904/kjim.2021.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/AIMS The obesity paradox has been known in end-stage renal disease (ESRD). However, the effect of body mass index (BMI) or waist circumference (WC) prior to percutaneous coronary intervention (PCI) on the development of ESRD is not clear. METHODS Using nationally representative data from the Korean National Health Insurance System, we enrolled 140,164 subjects without ESRD at enrolment who underwent PCI between 2010 and 2015, and were followed-up until 2017. Patients were stratified into five levels based on their baseline BMI and six levels based on their WC with 5-cm increments. BMI and WC were measured at least 2 years prior to PCI. The primary outcome was the development of ESRD. RESULTS During a median follow-up of 5.4 years, 2,082 (1.49%) participants developed ESRD. The underweight group (hazard ratio [HR], 1.331; 95% confidence interval [CI], 0.955 to 1.856) and low WC (< 80/< 75) (HR, 1.589; 95% CI, 1.379 to 1.831) showed the highest ESRD risk and the BMI 25 to 30 group showed the lowest ESRD risk (HR, 0.604; 95% CI, 0542 to 0.673) in all participants after adjusting for all covariates. In the subgroup analysis for diabetes mellitus (DM) duration, WC < 85/80 cm (men/women) increased ESRD risk in only the DM group (DM < 5 years and DM ≥ 5 years) compared to the reference group (85-90/80-85 of WC), but not the normal or impaired fasting glucose group. CONCLUSION Low WC prior to PCI showed an increased ESRD risk in patients with DM undergoing PCI as compared to those without DM.
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Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Sang Yup Lim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan,
Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Hospital, Gwangju,
Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul,
Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul,
Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju,
Korea
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Hong YH, Chung IH, Han K, Chung S. Prevalence of Type 2 Diabetes Mellitus among Korean Children, Adolescents, and Adults Younger than 30 Years: Changes from 2002 to 2016. Diabetes Metab J 2022; 46:297-306. [PMID: 34695908 PMCID: PMC8987690 DOI: 10.4093/dmj.2021.0038] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/02/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite the importance of and social concern regarding prevention of diabetes at younger ages, limited data are available. This study sought to analyze changes in the prevalence of type 2 diabetes mellitus (T2DM) in Koreans younger than 30 years according to sex, age, and level of income. METHODS The dataset analyzed in this study was derived from health insurance claims recorded in the National Health Insurance Service (NHIS) database. Participants' level of income was categorized as low (quintile 1, <20% of insurance premium) or others (quintile 2-5). RESULTS In males and females, the prevalence of T2DM per 10,000 people steadily increased from 2.57 in 2002 to 11.41 in 2016, and from 1.96 in 2002 to 8.63 in 2016. The prevalence of T2DM in girls was higher in the age group of 5 to 14 years. Even though the prevalence was higher among those older than 20 years, the increase had started earlier, in the early 2000s, in younger age group. Adolescents aged 10 to 19 years in low-income families showed a remarkable increase in prevalence of T2DM, especially in boys. CONCLUSION The prevalence of T2DM in young Koreans increased more than 4.4-fold from 2002 to 2016, and the increase started in the early 2000s in younger age groups and in low-income families. This is the first study to examine the trend in prevalence of T2DM in children, adolescents, and young adults in Korea. Future studies and collaborations with social support systems to prevent T2DM at an early age group should be performed.
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Affiliation(s)
- Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - In-Hyuk Chung
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
- Corresponding author: Sochung Chung https://orcid.org/0000-0002-7655-2691 Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, 20-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea E-mail:
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12
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Um YH, Kim TW, Jeong JH, Hong SC, Seo HJ, Han KD. Association Between Diabetic Retinopathy and Insomnia Risk: A Nationwide Population-Based Study. Front Endocrinol (Lausanne) 2022; 13:939251. [PMID: 35909567 PMCID: PMC9333090 DOI: 10.3389/fendo.2022.939251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies have suggested a close link between sleep disturbances and diabetic retinopathy (DR). However, to date, no confirmatory findings have been reported. We aimed to explore the risk of insomnia in DR by considering demographic factors and diabetes mellitus (DM)-related variables. METHODS A nationwide population-based cohort of 2,206,619 patients with type 2 diabetes from the Korean National Insurance Service Database was followed up for insomnia incidence. DR, non-proliferative DR (NPDR), and proliferative DR (PDR) were defined according to ICD-10 codes. The interactive effects of sex, age, and DM-related variables were analyzed to evaluate their impact on insomnia risk in DR. RESULTS Compared with the non-DR group, insomnia risk was increased in the DR [(adjusted hazard ratio (aHR): 1.125, 95% confidence interval (CI):1.108-1.142), NPDR (aHR:1.117, 95% CI:1.099-1.134), and PDR (aHR:1.205, 95% CI: 1.156-1.256), even after controlling for comorbidities, lifestyle factors, and DM-related variables. The men and youngest age groups (<40 years) were most vulnerable to insomnia risk. Sex, age, DM duration, and chronic kidney disease (CKD) status exerted interactive effects with DR status in increasing the insomnia risk. In the PDR group, sex, age, DM duration, insulin therapy status, and CKD status exerted interactive effects that increased the risk of insomnia. CONCLUSION Insomnia risk is significantly higher in patients with DR, and clinical attention is warranted.
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Affiliation(s)
- Yoo Hyun Um
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Tae-Won Kim
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung-Chul Hong
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ho-Jun Seo
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- *Correspondence: Ho-Jun Seo, ; Kyung-Do Han,
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
- *Correspondence: Ho-Jun Seo, ; Kyung-Do Han,
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13
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Bae EH, Oh TR, Suh SH, Yang EM, Choi HS, Kim CS, Ma SK, Kim B, Han KD, Kim SW. Underweight and Weight Change Increases End-Stage Renal Disease Risk in Patients with Diabetes: A Nationwide Population-Based Cohort Study. Nutrients 2021; 14:nu14010154. [PMID: 35011029 PMCID: PMC8747041 DOI: 10.3390/nu14010154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 12/23/2022] Open
Abstract
Weight variability has known as a risk factor for cardiovascular events and mortality. However, its effect on end-stage renal disease (ESRD) development remains controversial. We investigated the relationship between weight change and ESRD risk. Overall, 97,029 patients with DM aged >20 years were selected from the Korean National Health Screening Program 2009–2012. Weight change was defined as differences in body weight from the index year to 2 years later. Newly diagnosed ESRD was observed until 2017 end. Over a 5.1-year median follow-up period, ESRD was newly diagnosed in 7932 (4.81%) DM patients. BMI < 18.5 kg/m2 and waist circumferences <85/80 and >100/95 cm were ESRD risk factors. ESRD risk increased with increasing weight change; ≥10% weight loss (hazard ratio [HR], 1.247) followed by ≥10% weight gain (1.247) was associated with a higher HR than ≤5% weight change after adjusting for several confounding factors. The association between weight change and ESRD risk in a subgroup analysis was significantly stronger in patients aged <65 years, without proteinuria, with BMI ≥ 25, with DM duration <5 years, and prescribed less than 3 classes of DM medication. Underweight patients showed higher ESRD risks than overweight patients. Weight loss >10% was associated with the fastest decline in renal function.
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Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (S.H.S.); (E.M.Y.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (S.H.S.); (E.M.Y.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea
| | - Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (S.H.S.); (E.M.Y.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea
| | - Eun Mi Yang
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (S.H.S.); (E.M.Y.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (S.H.S.); (E.M.Y.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (S.H.S.); (E.M.Y.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (S.H.S.); (E.M.Y.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul 06978, Korea;
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul 06978, Korea;
- Correspondence: (K.-D.H.); (S.W.K.); Tel.: +82-2-820-7025 (K.-D.H.); +82-62-220-6271 (S.W.K.); Fax: +82-2-823-1746 (K.-D.H.); +82-62-225-8578 (S.W.K.)
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (S.H.S.); (E.M.Y.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, 42 Jebongro, Gwangju 61469, Korea
- Correspondence: (K.-D.H.); (S.W.K.); Tel.: +82-2-820-7025 (K.-D.H.); +82-62-220-6271 (S.W.K.); Fax: +82-2-823-1746 (K.-D.H.); +82-62-225-8578 (S.W.K.)
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14
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Ha J, Jeong C, Han KD, Lim Y, Kim MK, Kwon HS, Song KH, Kang MI, Baek KH. Comparison of fracture risk between type 1 and type 2 diabetes: a comprehensive real-world data. Osteoporos Int 2021; 32:2543-2553. [PMID: 34333678 DOI: 10.1007/s00198-021-06032-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/11/2021] [Indexed: 12/24/2022]
Abstract
UNLABELLED Population-based cohort study of 6,548,784 Korean subjects demonstrates that the risk of fracture was higher in patients with diabetes than in nondiabetic subjects. Furthermore, patients with type 1 diabetes were associated with a higher risk of fracture than patients with type 2 diabetes for all measurement sites. INTRODUCTION Diabetes mellitus is associated with increased fracture risk. Although the pathophysiologic effect on bone metabolism differs according to the type of diabetes, a higher risk of fracture in patients with diabetes than in nondiabetic patients has been consistently demonstrated. Considering the ever-increasing number of patients with diabetes, we aimed to provide updated information on whether this phenomenon remains valid in real-world settings by using large-scale population datasets. METHODS We conducted a retrospective longitudinal study using data from the Korean National Health Insurance Service dataset of preventive health check-ups between January 2009 and December 2016. The hazard ratios were calculated for any fracture, vertebral fracture, and hip fracture and were analyzed according to the presence and type of diabetes. Among 10,585,818 subjects, 6,548,784 were eligible for the analysis (2418 patients with type 1 diabetes mellitus [T1DM] and 506,208 patients with type 2 diabetes mellitus [T2DM]). RESULTS The mean follow-up duration (in years) was 7.0 ± 1.3 for subjects without diabetes, 6.4 ± 2.0 for those with T1DM, and 6.7 ± 1.7 for T2DM. Patients with T1DM had a higher incidence rate for all types of fractures per 1000 person-years. The fully adjusted hazard ratios (HRs) for any fracture, vertebral fracture, and hip fracture were higher in T1DM than in T2DM (1.37 [95% confidence interval (CI): 1.23-1.52] for any fracture, 1.33 [95% CI: 1.09-1.63] for vertebral fracture, and 1.99 [95% CI: 1.56-2.53] for hip fracture). CONCLUSIONS In this large-scale population analysis, diabetes was associated with a higher risk of all types of fractures. Patients with T1DM had a higher risk of fracture than those with T2DM for all measurement sites, and hip fractures had the highest risk. Therefore, fracture prevention training for patients with diabetes is advisable.
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Affiliation(s)
- J Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - C Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K-D Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Y Lim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - M K Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H-S Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K-H Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - M I Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K-H Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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15
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Lee YB, Kim B, Han K, Kim JA, Roh E, Hong SH, Choi KM, Baik SH, Yoo HJ. Combination of Statin and Ezetimibe versus Statin Monotherapy on Cardiovascular Disease and Type 2 Diabetes Incidence among Adults with Impaired Fasting Glucose: a Propensity-Matched Nationwide Cohort Study. J Lipid Atheroscler 2021; 10:303-312. [PMID: 34621701 PMCID: PMC8473964 DOI: 10.12997/jla.2021.10.3.303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 12/24/2022] Open
Abstract
Objective We investigated the effects of statin-ezetimibe combination therapy compared with statin-only treatment on the hazard of incident type 2 diabetes (T2D), myocardial infarction (MI), and stroke among adults with impaired fasting glucose (IFG) in a real-world setting. Methods The Korean National Health Insurance Service datasets from 2002 to 2017 were used for this propensity-matched nationwide cohort study. Among 56,633 IFG patients without baseline cardiovascular disease (CVD) and/or T2D who initiated statin therapy with or without ezetimibe, 1,155 with statin-ezetimibe combination therapy were matched based on a propensity score at a 1:5 ratio with 5,775 patients who received statin monotherapy. The hazards of T2D, MI, and stroke were compared between these treatment groups. Results The incidence rate per 1,000 person-years was 19.62 (statin monotherapy group) and 21.02 (combined treatment group) for T2D, 1.53 (statin monotherapy group) and 1.70 (combined treatment group) for MI, and 1.99 (statin monotherapy group) and 2.06 (combined treatment group) for stroke. The hazards of T2D, MI, and stroke were not significantly different between the statin monotherapy group and the statin-ezetimibe combination therapy group. Conclusion The combination of ezetimibe in addition to statin treatment was not associated with a significantly different risk of T2D and CVDs compared with statin monotherapy in Korean adults with IFG.
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Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Bongsung Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - So-Hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Lee Y, Han K, Kim B, Choi MS, Park J, Kim M, Jin S, Hur KY, Kim G, Kim JH. Risk of early mortality and cardiovascular disease according to the presence of recently diagnosed diabetes and requirement for insulin treatment: A nationwide study. J Diabetes Investig 2021; 12:1855-1863. [PMID: 33662172 PMCID: PMC8504914 DOI: 10.1111/jdi.13539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS/INTRODUCTION We estimated the hazards of cardiovascular diseases (CVDs) and early all-cause mortality in Korean adults according to the presence of recently diagnosed type 2 diabetes (type 2 diabetes for <5 years) and insulin use. MATERIALS AND METHODS We used the Korean National Health Insurance Service-National Sample Cohort database (2002-2015) for this longitudinal population-based study. Among adults aged ≥40 years without baseline CVD, individuals without diabetes or with recently diagnosed type 2 diabetes were selected (N = 363,919). The hazard ratios (HRs) for myocardial infarction (MI), stroke, and all-cause mortality during follow-up were analyzed according to three groups categorized by the presence of type 2 diabetes and insulin use. RESULTS Within a mean 7.8 years, there were 5,275 MIs, 7,220 strokes, and 15,834 deaths. The hazards for outcomes were higher in the insulin-treated type 2 diabetes group than in the non-diabetes group [HR (95% CI): 2.344 (1.870-2.938) for MI, 2.420 (1.993-2.937) for stroke, and 3.037 (2.706-3.407) for death], higher in the non-insulin-treated type 2 diabetes group than in the non-diabetes group [HR (95% CI): 1.284 (1.159-1.423) for MI, 1.435 (1.320-1.561) for stroke, and 1.135 (1.067-1.206) for death], and higher in the insulin-treated type 2 diabetes group than in the non-insulin-treated type 2 diabetes group [HR (95% CI): 1.914 (1.502-2.441) for MI, 1.676 (1.363-2.060) for stroke, and 2.535 (2.232-2.880) for death]. CONCLUSIONS Recently diagnosed type 2 diabetes patients showed increased risks of incident CVDs and premature mortality, and insulin-treated group demonstrated an additional increase in the risks of these outcomes in adults with recently diagnosed type 2 diabetes, suggesting the need for intensified cardio-protective interventions for adults with insulin-treated type 2 diabetes.
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Affiliation(s)
- You‐Bin Lee
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Kyungdo Han
- Department of Statistics and Actuarial ScienceSoongsil UniversitySeoulKorea
| | - Bongsung Kim
- Department of Statistics and Actuarial ScienceSoongsil UniversitySeoulKorea
| | - Min Sun Choi
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jiyun Park
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Minyoung Kim
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Sang‐Man Jin
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Kyu Yeon Hur
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Gyuri Kim
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jae Hyeon Kim
- Division of Endocrinology and MetabolismDepartment of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
- Department of Clinical Research Design and EvaluationSamsung Advanced Institute for Health Sciences and TechnologySungkyunkwan UniversitySeoulKorea
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Kim SR, Choi S, Kim K, Chang J, Kim SM, Cho Y, Oh YH, Lee G, Son JS, Kim KH, Park SM. Association of the combined effects of air pollution and changes in physical activity with cardiovascular disease in young adults. Eur Heart J 2021; 42:2487-2497. [PMID: 33780974 DOI: 10.1093/eurheartj/ehab139] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/16/2020] [Accepted: 02/19/2021] [Indexed: 12/31/2022] Open
Abstract
AIMS Little is known about the trade-off between the health benefits of physical activity (PA) and the potential harmful effects of increased exposure to air pollution during outdoor PA. We examined the association of the combined effects of air pollution and changes in PA with cardiovascular disease (CVD) in young adults. METHODS AND RESULTS This nationwide cohort study included 1 469 972 young adults aged 20-39 years. Air pollution exposure was estimated by the annual average cumulative level of particulate matter (PM). PA was calculated as minutes of metabolic equivalent tasks per week (MET-min/week) based on two consecutive health examinations from 2009 to 2012. Compared with the participants exposed to low-to-moderate levels of PM2.5 or PM10 who continuously engaged in ≥1000 MET-min/week of PA, those who decreased their PA from ≥1000 MET-min/week to 1-499 MET-min/week [PM10 adjusted hazard ratio (aHR) 1.22; 95% confidence interval (CI) 1.00-1.48] and to 0 MET-min/week (physically inactive; PM10 aHR 1.38; 95% CI 1.07-1.78) had an increased risk of CVD (P for trend <0.01). Among participants exposed to high levels of PM2.5 or PM10, the risk of CVD was elevated with an increase in PA above 1000 MET-min/week. CONCLUSION Reducing PA may lead to subsequent elevation of CVD risk in young adults exposed to low-to-moderate levels of PM2.5 or PM10, whereas a large increase in PA in a high-pollution environment may adversely affect cardiovascular health.
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Affiliation(s)
- Seong Rae Kim
- Department of Medicine, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Kyuwoong Kim
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Jooyoung Chang
- Department of Biomedical Sciences, Seoul National University Graduate School, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Yoosun Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Yun Hwan Oh
- Department of Family Medicine, Jeju National University School of Medicine, Jeju National University Hospital, 15, Aran 13-gil, Jeju-si, Jeju 63241, South Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Joung Sik Son
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Kyae Hyung Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea.,Institute for Public Health and Medical Service, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea.,Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
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Lee SE, Kim KA, Son KJ, Song SO, Park KH, Park SH, Nam JY. Trends and risk factors in severe hypoglycemia among individuals with type 2 diabetes in Korea. Diabetes Res Clin Pract 2021; 178:108946. [PMID: 34252506 DOI: 10.1016/j.diabres.2021.108946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/24/2022]
Abstract
AIMS Because of the development of new classes of antidiabetic drugs, hypoglycemic events were expected to decrease. We investigated the trends and risk factors for severe hypoglycemia in subjects with type 2 diabetes in Korea. METHODS We conducted repeated cross-sectional analyses using a Korean National Health Insurance Service-National Sample Cohort from 2006 to 2015. Severe hypoglycemia was defined as hospitalization or a visit to an emergency department with diagnosis of hypoglycemia using ICD-10 codes. RESULTS During the study period, the prevalence of type 2 diabetes continuously increased. The percentage of patients prescribed metformin and dipeptidyl peptidase-4 inhibitor increased, while the use of sulfonylurea decreased considerably, especially since 2009. The proportion of patients prescribed ≥3 classes of drugs continually increased. Age-standardized incidence of severe hypoglycemia per 1000 patients with diabetes increased from 6.00 to 8.24 between 2006 and 2010, and then fell to 6.49 in 2015. Predictors of severe hypoglycemia included female, older age, comorbidities, polypharmacy, and sulfonylurea or insulin usage. CONCLUSIONS Trends of severe hypoglycemia were associated with changes in drug classes rather than number of antidiabetic drugs. Relentless efforts to reduce the prescription of drugs with a high risk of hypoglycemia should be implemented, particularly for older women with multiple comorbidities.
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Affiliation(s)
- Seung Eun Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
| | - Kyoung-Ah Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
| | - Kang Ju Son
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Republic of Korea.
| | - Sun Ok Song
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
| | - Kyeong Hye Park
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
| | - Se Hee Park
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
| | - Joo Young Nam
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
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Bae EH, Lim SY, Jung JH, Oh TR, Choi HS, Kim CS, Ma SK, Han KD, Kim SW. Obesity, Abdominal Obesity and Chronic Kidney Disease in Young Adults: A Nationwide Population-Based Cohort Study. J Clin Med 2021; 10:jcm10051065. [PMID: 33806552 PMCID: PMC7962022 DOI: 10.3390/jcm10051065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 11/17/2022] Open
Abstract
Obesity has become a pandemic. It is one of the strongest risk-factors of new-onset chronic kidney disease (CKD). However, the effects of obesity and abdominal obesity on the risk of developing CKD in young adults has not been elucidated. From a nationwide health screening database, we included 3,030,884 young adults aged 20–39 years without CKD during a baseline examination in 2009–2010, who could follow up during 2013–2016. Patients were stratified into five levels based on their baseline body mass index (BMI) and six levels based on their waist circumference (WC; 5-cm increments). The primary outcome was the development of CKD. During the follow up, until 2016, 5853 (0.19%) participants developed CKD. Both BMI and WC showed a U-shaped relationship with CKD risk, identifying the cut-off values as a BMI of 21 and WC of 72 cm in young adults. The obesity group (odd ratio [OR] = 1.320, 95% confidence interval [CI]: 1.247–1.397) and abdominal obesity group (male WC ≥ 90, female WC ≥ 85) (OR = 1.208, 95%CI: 1.332–1.290) showed a higher CKD risk than the non-obesity or non-abdominal obesity groups after adjusting for covariates. In the CKD risk by obesity composite, the obesity displayed by the abdominal obesity group showed the highest CKD risk (OR = 1.502, 95%CI: 1.190–1.895), especially in those under 30 years old. During subgroup analysis, the diabetes mellitus (DM) group with obesity or abdominal obesity paradoxically showed a lower CKD risk compared with the non-obesity or non-abdominal obesity group. Obesity and abdominal obesity are associated with increased risk of developing CKD in young adults but a decreased risk in young adults with diabetes.
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Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnan National University Medical School, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, Korea
| | - Sang Yeob Lim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15459, Korea;
| | - Jin-Hyung Jung
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnan National University Medical School, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnan National University Medical School, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnan National University Medical School, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnan National University Medical School, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil Universithy, Seoul 06978, Korea
- Correspondence: (K.-D.H.); (S.W.K.); Tel.: +82-2-820-7025 (K.-D.H.); +82-62-220-6271 (S.W.K.)
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnan National University Medical School, Gwangju 61469, Korea; (E.H.B.); (T.R.O.); (H.S.C.); (C.S.K.); (S.K.M.)
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, Korea
- Correspondence: (K.-D.H.); (S.W.K.); Tel.: +82-2-820-7025 (K.-D.H.); +82-62-220-6271 (S.W.K.)
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Tesfaye A, Josef H, Wube TB, Girma Z, Negasa B, Muche T, Zewude B. Magnitude of, and Factors Associated with Cardiovascular Disease Among Type Two Diabetes Mellitus Patients. Diabetes Metab Syndr Obes 2020; 13:4123-4129. [PMID: 33177852 PMCID: PMC7649970 DOI: 10.2147/dmso.s254883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/09/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Diabetes mellitus is becoming one of the major health problems in developing countries. The number of adults living with type 2 diabetes mellitus (T2DM) worldwide is increasing over time. Cardiovascular disease (CVD) is the major cause of death in T2DM. The objective of this study was to determine the prevalence of cardiovascular disease and its associated factors among diabetic patients at the MRC clinic of Dilla University Referral Hospital (DURH). METHODS A hospital-based cross-sectional study was conducted from April to May 2019 . A total of 216 diabetic individuals were selected with a convenient sampling technique from patients on follow-up at DURH MRC. Data were collected using a structured format. The diagnosis of CVD was made with the necessary diagnostic tests and examination. The data analysis was done in SPSS software version 20. Bivariate and multivariable logistic regression analysis was carried out to identify factors associated with cardiovascular disease. RESULTS A total of 216 patients participated in the study and the mean age of the study participants was 30 years; 83.3% of the study participants were male. The overall prevalence of cardiovascular disease was 25% of which 57% were ischemic heart disease, 32% were hypertensive and 10% were stroke. Duration of DM for more than 10 years and diabetic drug discontinuation were factors associated with cardiovascular disease. Odds of CVD was nearly four times more in those whose duration of DM is more than 10 years (AOR=4.00, 95% CI: 2.386-6.705) and odds of CVD among those who discontinued medication were almost three times more, (AOR=2.98, 95% CI: 1.287-6.080). CONCLUSION A quarter of the diabetic population studied developed CVD. Duration of DM for more than 10 years and drug discontinuation are independent associated factors of CVD. Hence appropriate intervention at early stages should be implemented at primary healthcare level.
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Affiliation(s)
- Adane Tesfaye
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Haileyesus Josef
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Temesgen Bizuayehu Wube
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Zeleke Girma
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Belay Negasa
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Temesgen Muche
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Bewnetu Zewude
- Department of Sociology, College of Social Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Chauhan PS, Yadav D, Tayal S, Jin JO. Therapeutic Advancements in the Management of Diabetes Mellitus with Special Reference to Nanotechnology. Curr Pharm Des 2020; 26:4909-4916. [PMID: 32851952 DOI: 10.2174/1381612826666200826135401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/25/2020] [Indexed: 12/11/2022]
Abstract
For improvisation of diabetic's quality of life, nanotechnology is facilitating the development of advanced glucose sensors as well as efficient insulin delivery systems. Our prime focus of the review is to highlight the advancement in diabetic research with special reference to nanotechnology at its interface. Recent studies are more focused on enhancing sensitivity, accuracy, and response by employing metal as well as nanoparticles based glucose sensors. Moreover, the review focuses on nanoscale based approaches i.e. closed-loop insulin delivery systems, which detect any fluctuation in blood glucose levels and allow controlled release of a drug, thus are also called self-regulating insulin release system. Additionally, this review summarizes the role of nanotechnology in the diagnosis and treatment of diabetic complications through little advancement in the existing techniques. To improve health, as well as the quality of life in diabetic's new sensing systems for blood glucose level evaluation and controlled administration of drugs through efficient drug delivery systems should be explored.
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Affiliation(s)
- Pallavi Singh Chauhan
- Amity Institute of Biotechnology, Amity University Madhya Pradesh, Gwalior (M.P.), India
| | - Dhananjay Yadav
- Department of Medical Biotechnology, Yeungnam University, Gyeongsan, 712-749, South Korea
| | - Shivam Tayal
- School of Pharmacy, ITM University, Gwalior, Madhya Pradesh, India
| | - Jun-O Jin
- Research Institute of Cell Culture, Yeungnam University, Gyeongsan 38541, South Korea
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22
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Lee YB, Kim DH, Kim SM, Kim NH, Choi KM, Baik SH, Park YG, Han K, Yoo HJ. Risk of type 2 diabetes according to the cumulative exposure to metabolic syndrome or obesity: A nationwide population-based study. J Diabetes Investig 2020; 11:1583-1593. [PMID: 32449283 PMCID: PMC7610118 DOI: 10.1111/jdi.13304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/25/2020] [Accepted: 05/14/2020] [Indexed: 12/29/2022] Open
Abstract
Aims/Introduction We investigated the risk of incident type 2 diabetes according to the cumulative exposure to obesity or metabolic syndrome (MetS) during annual or biennial health examinations. Materials and Methods The Korean National Health Insurance Service datasets from 2002 to 2017 were used for this retrospective longitudinal study. The risk for type 2 diabetes was analyzed according to the cumulative exposure to obesity and MetS among individuals who underwent four health examinations from 2009 to 2012 or 2013 (n = 2,851,745). Results During examinations, 28.56 and 17.86% of the total participants showed fluctuations in metabolic health state and obesity, respectively. During a mean 5.01 years of follow up, 98,950 new type 2 diabetes cases developed. The risk for type 2 diabetes increased with the increase in exposure to MetS (hazard ratio [HR] 2.92, 95% confidence interval [CI] 2.86–2.99; HR 4.96, 95% CI 4.85–5.08; HR 7.46, 95% CI 7.30–7.63; HR 12.24, 95% CI 12.00–12.49 in groups with number of exposures one to four, respectively) and obesity (HR 1.60, 95% CI 1.56–1.65; HR 1.87, 95% CI 1.81–1.92; HR 2.25, 95% CI 2.19–2.31; HR 3.46, 95% CI 3.41–3.51 in groups with number of exposures one to four, respectively), showing a more detrimental effect of cumulative exposure to MetS, when compared with the exposure to obesity. Conclusions Metabolic health and obesity fluctuated within a relatively short period of 4–5 years. Although the impact was much greater for MetS than for obesity, the cumulative duration of both obesity and MetS was associated with an increased risk of type 2 diabetes in a dose‐response manner. Therefore, continuously maintaining metabolic health and normal weight is crucial to prevent incident type 2 diabetes.
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Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Da Hye Kim
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seon Mee Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Lee HJ, Choi EK, Han KD, Kim DH, Lee E, Lee SR, Oh S, Lip GYH. High variability in bodyweight is associated with an increased risk of atrial fibrillation in patients with type 2 diabetes mellitus: a nationwide cohort study. Cardiovasc Diabetol 2020; 19:78. [PMID: 32534567 PMCID: PMC7293783 DOI: 10.1186/s12933-020-01059-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022] Open
Abstract
Background Bodyweight variability is a risk factor for atrial fibrillation (AF). We aimed to examine the relationship between bodyweight variability and the risk of AF in patients with type 2 diabetes mellitus (DM), and whether this relationship was affected by baseline body mass index (BMI), weight change, or advanced diabetic stage. Methods A nationwide population-based cohort of 670,797 patients with type 2 DM from the Korean National Health Insurance Service database without a history of AF and with ≥ 3 measurements of bodyweight over a 5-year period were followed up for AF development. Intra-individual bodyweight variability was calculated using variability independent of mean, and high bodyweight variability was defined as the quintile with the highest variability with the lower four quintiles as reference. Results During a median of 7.0 years of follow-up, 22,019 patients (3.3%) newly developed AF. After multivariate adjustment, those in the highest quintile of bodyweight variability showed a higher risk of incident AF (HR 1.16, 95% CI 1.12–1.20) compared to those in the lower 4 quintiles with reference bodyweight variability, irrespective of baseline BMI group and direction of overall weight change. This association was greater in magnitude in subjects with lower BMI, those on insulin, and those with a DM duration of greater than 5 years. In sensitivity analyses, high bodyweight variability was consistently associated with AF development using other indices of variability and adjusting for glycemic variability. Conclusions High variability in bodyweight was associated with AF development, independently of traditional cardiovascular risk factors and baseline BMI. This association was stronger in underweight patients and with advanced diabetic stage. Weight fluctuation may interfere with the beneficial effects of weight loss and should be avoided when possible in weight control regimens for DM patients.
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Affiliation(s)
- Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Da Hye Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Euijae Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Kim YH, Kang JG, Lee SJ, Han KD, Ihm SH, Cho KH, Park YG. Underweight Increases the Risk of End-Stage Renal Diseases for Type 2 Diabetes in Korean Population: Data From the National Health Insurance Service Health Checkups 2009-2017. Diabetes Care 2020; 43:1118-1125. [PMID: 32188773 DOI: 10.2337/dc19-2095] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/17/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There is a controversy over the association between obesity and end-stage renal disease (ESRD) in people with or without type 2 diabetes; therefore, we examined the effect of BMI on the risk of ESRD according to glycemic status in the Korean population. RESEARCH DESIGN AND METHODS The study monitored 9,969,848 participants who underwent a National Health Insurance Service health checkup in 2009 from baseline to the date of diagnosis of ESRD during a follow-up period of ∼8.2 years. Obesity was categorized by World Health Organization recommendations for Asian populations, and glycemic status was categorized into the following five groups: normal, impaired fasting glucose (IFG), newly diagnosed diabetes, diabetes <5 years, and diabetes ≥5 years. RESULTS Underweight was associated with a higher risk of ESRD in all participants after adjustment for all covariates. In the groups with IFG, newly diagnosed type 2 diabetes, diabetes duration <5 years, and diabetes ≥5 years, the hazard ratio (HR) of the underweight group increased with worsening glycemic status (HR 1.431 for IFG, 2.114 for newly diagnosed diabetes, 4.351 for diabetes <5 years, and 6.397 for diabetes ≥5 years), using normal weight with normal fasting glucose as a reference. The adjusted HRs for ESRD were also the highest in the sustained underweight group regardless of the presence of type 2 diabetes (HR 1.606 for nondiabetes and 2.14 for diabetes). CONCLUSIONS Underweight showed more increased HR of ESRD according to glycemic status and diabetes duration in the Korean population. These associations also persisted in the group with sustained BMI during the study period.
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Affiliation(s)
- Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jun Goo Kang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Seong Jin Lee
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyung-do Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, Korea
| | - Sung-Hee Ihm
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyung-Hwan Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yong-Gyu Park
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, Korea
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Lee YB, Kim DH, Roh E, Hong SH, Kim JA, Yoo HJ, Baik SH, Han K, Choi KM. Variability in estimated glomerular filtration rate and the incidence of type 2 diabetes: a nationwide population-based study. BMJ Open Diabetes Res Care 2020; 8:8/1/e001187. [PMID: 32317303 PMCID: PMC7202740 DOI: 10.1136/bmjdrc-2020-001187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/14/2020] [Accepted: 03/28/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Variability in estimated glomerular filtration rate (eGFR) has been associated with adverse outcomes in patients with diabetes or chronic kidney disease (CKD). However, no previous study has explored the relationship between eGFR variability and type 2 diabetes incidence. RESEARCH DESIGN AND METHODS In this nationwide, longitudinal, cohort study, we investigated the association between eGFR variability and type 2 diabetes risk using the Korean National Health Insurance Service datasets from 2002 to 2017. eGFR variability was calculated using the variability independent of the mean (eGFR-VIM), coefficient of variation (eGFR-CV), standard deviation (eGFR-SD) and average real variability (eGFR-ARV). RESULTS Within 7 673 905.58 person-years of follow-up (mean follow-up: 3.19 years; n=2 402 668), 11 981 cases of incident type 2 diabetes were reported. The HRs and 95% CIs for incident type 2 diabetes increased according to advance in quartiles of eGFR-VIM (HR (95% CI): Q2, 1.068 (1.009 to 1.130); Q3, 1.077 (1.018 to 1.138); Q4, 1.203 (1.139 to 1.270)) even after adjusting for confounding factors including mean eGFR and mean fasting plasma glucose levels. The subgroup analyses according to risk factors as well as analyses using eGFR-CV, eGFR-SD and eGFR-ARV showed consistent results. The association between increased eGFR variability and type 2 diabetes risk was more prominent in men, individuals with dyslipidemia and those with CKD as shown in the subgroup analysis (p for interaction <0.001). CONCLUSIONS Increased eGFR variability may be an independent predictor of type 2 diabetes and might be useful for risk stratification of individuals without diabetes.
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Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Da Hye Kim
- Department of Biostatistics, Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - So-Hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea
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Koo DH, Han KD, Kim HJ, Park CY. Middle-aged men with type 2 diabetes as potential candidates for pancreatic cancer screening: a 10-year nationwide population-based cohort study. Acta Diabetol 2020; 57:197-202. [PMID: 31420738 DOI: 10.1007/s00592-019-01405-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/08/2019] [Indexed: 01/08/2023]
Abstract
AIMS Before developing a national screening program for pancreatic cancer, more detailed and reliable estimation of pancreatic cancer incidence rate is needed according to sex, age, and diabetes mellitus status. METHODS Among populations who underwent a biennial or annual evaluation provided by the National Health Insurance Service Database of Claims between 2006 and 2015, data were evaluated from the medical records of 34.2 million individuals aged 30 years and over. RESULTS The annual incidence rate (IR; per 100,000) of pancreatic cancer in 2006 was 5.96, and the IR in 2015 increased to 8.92. The IRs increased consistently and significantly with age (p for trend < 0.0001). The incidence rate ratio (IRR; after adjusting for age and sex) of pancreatic cancer was higher (about 1.5 times) in males than in females for all ages. In particular, the IR (15.8) of pancreatic cancer between 50 and 59 years in patients with diabetes was strikingly higher compared to that in patients without diabetes (IR 7.6). Furthermore, the pancreatic cancer IR (19.1) of men with diabetes between 50 and 59 years was similar to the IR (20.2) in women with diabetes between 60 and 69 years, and it was even greater than the IR (17.0) in non-diabetic women between 60 and 69 years. CONCLUSIONS In middle-aged populations, men with type 2 diabetes had the highest relative risk. Their annual incidence rate of pancreatic cancer persistently increased and was higher by about 10-30% than in women with diabetes.
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Affiliation(s)
- Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Do Han
- Department of Biostatistics, Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Korea.
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Hong S, Han K, Park CY. Outcomes for Inappropriate Renal Dose Adjustment of Dipeptidyl Peptidase-4 Inhibitors in Patients With Type 2 Diabetes Mellitus: Population-Based Study. Mayo Clin Proc 2020; 95:101-112. [PMID: 31812252 DOI: 10.1016/j.mayocp.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/20/2019] [Accepted: 06/05/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To estimate inappropriate dosing of dipeptidyl peptidase-4 (DPP-4) inhibitors and to assess the risk of emergency department visits, hypoglycemia, and mortality in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) prescribed inappropriate DPP-4 inhibitor doses because limited real-world information is available regarding rates of DPP-4 inhibitor dose adjustment and its safety in patients with T2DM and CKD. PATIENTS AND METHODS We performed a retrospective observational cohort study of 82,332 patients aged 30 to 75 years with T2DM and CKD being treated with DPP-4 inhibitors from January 1, 2012, through December 31, 2014, using the Korean National Health Information Database. We divided the patients according to the prescription of DPP-4 inhibitor with or without dose adjustment according to estimated glomerular filtration rate. The incidences of emergency department visits, hypoglycemia, and mortality were assessed using hazard ratios estimated using Cox proportional hazards regression modeling. RESULTS Approximately 40% of patients with T2DM and CKD were prescribed an inappropriate dose of DPP-4 inhibitor from 2009 through 2011; this proportion decreased to 24.4% in 2015. Hazard ratios (95% CIs) for inappropriate vs appropriate dosing of DPP-4 inhibitors were 1.115 (1.005-1.237) for mortality, 1.074 (1.018-1.133) for emergency department visits, and 1.192 (1.054-1.349) for severe hypoglycemia after multivariable adjustment for confounding factors. CONCLUSION One of every 3 patients with T2DM and CKD received inappropriate dosing of DPP-4 inhibitor, which was associated with high risk of emergency department visits, severe hypoglycemia, and mortality.
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Affiliation(s)
- Sangmo Hong
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Cheol-Young Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Lee YB, Han K, Kim B, Lee SE, Jun JE, Ahn J, Kim G, Jin SM, Kim JH. Risk of early mortality and cardiovascular disease in type 1 diabetes: a comparison with type 2 diabetes, a nationwide study. Cardiovasc Diabetol 2019; 18:157. [PMID: 31733656 PMCID: PMC6858684 DOI: 10.1186/s12933-019-0953-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background Both type 1 and type 2 diabetes are well-established risk factors for cardiovascular disease and early mortality. However, few studies have directly compared the hazards of cardiovascular outcomes and premature death among people with type 1 diabetes to those among people with type 2 diabetes and subjects without diabetes. Furthermore, information about the hazard of cardiovascular disease and early mortality among Asians with type 1 diabetes is sparse, although the clinical and epidemiological characteristics of Asians with type 1 diabetes are unlike those of Europeans. We estimated the hazard of myocardial infarction (MI), hospitalization for heart failure (HF), atrial fibrillation (AF), and mortality during follow-up in Korean adults with type 1 diabetes compared with those without diabetes and those with type 2 diabetes. Methods We used Korean National Health Insurance Service datasets of preventive health check-ups from 2009 to 2016 in this retrospective longitudinal study. The hazard ratios of MI, HF, AF, and mortality during follow-up were analyzed using the Cox regression analyses according to the presence and type of diabetes in ≥ 20-year-old individuals without baseline cardiovascular disease (N = 20,423,051). The presence and type of diabetes was determined based on the presence of type 1 or type 2 diabetes at baseline. Results During more than 93,300,000 person-years of follow-up, there were 116,649 MIs, 135,532 AF cases, 125,997 hospitalizations for HF, and 344,516 deaths. The fully-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident MI, hospitalized HF, AF, and all-cause death within the mean follow-up of 4.6 years were higher in the type 1 diabetes group than the type 2 diabetes [HR (95% CI) 1.679 (1.490–1.893) for MI; 2.105 (1.901–2.330) for HF; 1.608 (1.411–1.833) for AF; 1.884 (1.762–2.013) for death] and non-diabetes groups [HR (95% CI) 2.411 (2.138–2.718) for MI; 3.024 (2.730–3.350) for HF; 1.748 (1.534–1.993) for AF; 2.874 (2.689–3.073) for death]. Conclusions In Korea, the presence of diabetes was associated with a higher hazard of cardiovascular disease and all-cause death. Specifically, people with type 1 diabetes had a higher hazard of cardiovascular disease and all-cause mortality compared to people with type 2 diabetes.
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Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea
| | - Bongsung Kim
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul, 06978, Republic of Korea
| | - Seung-Eun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Konkuk University Medical Center, 210-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Ji Eun Jun
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Jiyeon Ahn
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Kim K, Choi S, Hwang SE, Son JS, Lee JK, Oh J, Park SM. Changes in exercise frequency and cardiovascular outcomes in older adults. Eur Heart J 2019; 41:1490-1499. [DOI: 10.1093/eurheartj/ehz768] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/28/2019] [Accepted: 10/11/2019] [Indexed: 01/19/2023] Open
Abstract
Abstract
Aims
Little is known about the association of changes in moderate to vigorous physical activity (MVPA) level with cardiovascular disease (CVD), especially in older adults whose ability to engage in frequent MVPA naturally wanes as they age. We aimed to examine the association of changes in MVPA and CVD in older adults.
Methods and results
In a nationwide cohort study of older adults aged 60 years or older, we identified more than 1.1 million subjects without previous history of CVD at baseline who underwent two consecutive national health screening from 2009 to 2012. We prospectively assessed the risk of CVD occurred between 2013 and 2016 according to changes in frequency of MVPA by initial MVPA status. Compared to those who were continuously physically inactive, those who increased their frequency of MVPA from physically inactive to 1–2 times per week [0.7/1000 person-years (PY) decrease in incidence rate (IR); adjusted hazard ratio (aHR) 0.95; 95% confidence interval (CI) 0.92–0.99], 3–4 times per week (1.5/1000 PY decrease in IR; aHR 0.89; 95% CI 0.84–0.94), ≥5 times per week (0.4/1000 PY decrease in IR; aHR 0.91; 95% CI 0.85–0.97) had a significantly reduced risk for total CVD (P for trend <0.001). Older adults who became physically inactive from engaging in more than 1–2 times of MVPA per week had a higher CVD risk compared to those who maintained their frequency of MVPA.
Conclusion
Among older adults, engaging in higher frequency of MVPA or maintaining MVPA level was associated with reduced risk of CVD.
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Affiliation(s)
- Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Biomedical Science Building 117, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Biomedical Science Building 117, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Seo Eun Hwang
- Department of Family Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Joung Sik Son
- Department of Family Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
| | - Jong-Koo Lee
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Rd, Durham, NC 27705, USA
- JW Lee Center for Global and Office of Health Society and Education, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03087, Republic of Korea
| | - Juhwan Oh
- JW Lee Center for Global and Office of Health Society and Education, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03087, Republic of Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Biomedical Science Building 117, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
- Department of Family Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea
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Lee YB, Han K, Kim B, Jun JE, Lee SE, Ahn J, Kim G, Jin SM, Kim JH. Risk of end-stage renal disease from chronic kidney disease defined by decreased glomerular filtration rate in type 1 diabetes: A comparison with type 2 diabetes and the effect of metabolic syndrome. Diabetes Metab Res Rev 2019; 35:e3197. [PMID: 31222888 DOI: 10.1002/dmrr.3197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/04/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND We estimated the end-stage renal disease (ESRD) risk of chronic kidney disease (CKD) in patients with type 1 diabetes (T1D). The ESRD risk of CKD in patients with T1D was compared with that of CKD in patients without diabetes and with type 2 diabetes (T2D). We also evaluated the predictive value of metabolic syndrome (MetS) for ESRD development in CKD patients with T1D. MATERIALS AND METHODS The Korean National Health Insurance Service datasets of preventive health check-ups from 2009 to 2016 were used. The risk of incident ESRD was analysed according to the presence and type of diabetes in CKD (defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 ) patients aged 20 years or older. Incident ESRD risk according to the presence of MetS was calculated among adult patients with CKD and T1D. RESULTS During 10 701 375.84 person-years of follow-up, 43 693 cases of ESRD developed. Hazard ratios (HRs) for incident ESRD from CKD in the T1D group were 2.580 (95% confidence interval [CI], 2.336-2.849) and 9.267 (95% CI, 8.378-10.251) compared with T2D and nondiabetes groups, respectively. In CKD patients with T1D, the presence of MetS increased incident ESRD risk by an HR of 2.023 (95% CI, 1.501-2.727). CONCLUSIONS The presence of diabetes increases the risk for ESRD development from CKD. Furthermore, patients with T1D have a higher risk for ESRD incidence from CKD than do patients with T2D in a Korean population. MetS may be a useful predictor for ESRD in CKD patients with T1D.
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Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bongsung Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Ji Eun Jun
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seung-Eun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jiyeon Ahn
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Seoul, Republic of Korea
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Koo DH, Han KD, Park CY. The Incremental Risk of Pancreatic Cancer According to Fasting Glucose Levels: Nationwide Population-Based Cohort Study. J Clin Endocrinol Metab 2019; 104:4594-4599. [PMID: 31498870 DOI: 10.1210/jc.2019-00033] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/12/2019] [Indexed: 12/22/2022]
Abstract
CONTEXT It has been unclear whether the risk of pancreatic cancer is different according to glucose levels. OBJECTIVE To determine the association between fasting glucose levels and pancreatic cancer risk using prospectively collected nationwide population-based cohort data in Korea. DESIGN The National Health Insurance Service database of claims and preventive health check-up data recorded was used between 2009 and 2015. SETTING AND PARTICIPANTS A total of 25.4 million patients who had participated in a preventive health check-up between 2009 and 2013 were evaluated for pancreatic cancer incidence rates according to fasting glucose level. MAIN OUTCOMES MEASURES The cumulative incidence rate for pancreatic cancer was calculated after grouping according to fasting glucose levels as follows: (i) low normal (<90 mg/dL), (ii) high normal (90 to 99 mg/dL), (iii) prediabetes level 1 (100 to 109 mg/dL), (iv) prediabetes level 2 (110 to 125 mg/dL), (v) diabetes (≥126 mg/dL), and (vi) diabetes on anti-diabetic medications. RESULTS The 5-year cumulative incidence rates (per 100,000) were as follows: (i) low normal = 32; (ii) high normal = 41; (iii) prediabetes level 1 = 50; (iv) prediabetes level 2 = 64; (v) diabetes = 75; and (vi) on anti-diabetic medications = 121. The risk of pancreatic cancer increased continuously with elevating fasting glucose levels (P < 0.0001). The incidence of pancreatic cancer increased significantly with increasing fasting blood glucose levels even after adjusting for age, sex, smoking, drinking, exercise, body mass index, and diabetes duration (P < 0.0001). CONCLUSIONS The cumulative incidence rate of pancreatic cancer significantly increased as the fasting glucose level elevated, even in populations with a normal glucose level range.
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Affiliation(s)
- Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Do Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choi YJ, Kim DJ, Shin S. Incident cancer risk in dipeptidyl peptidase-4 inhibitor-treated patients with type 2 diabetes mellitus. Cancer Manag Res 2019; 11:7427-7438. [PMID: 31496802 PMCID: PMC6689554 DOI: 10.2147/cmar.s215107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/22/2019] [Indexed: 12/29/2022] Open
Abstract
Objective It is known that patients with diabetes are susceptible to cancer development due to long-standing diabetic conditions. This study aimed to investigate new-onset cancer risk associated with dipeptidyl peptidase-4 (DPP-4) inhibitors as compared to metformin, the first-line antidiabetic agent with promising anticancer activity, in patients with type 2 diabetes mellitus (T2DM). Methods A retrospective cohort study of adult T2DM patients was performed at a tertiary care hospital in Korea. Patients who received comparison therapies during 2008–2017 were propensity score (PS)-matched in a 1:1 ratio either to the DPP-4 inhibitors group or to the metformin group in accordance with their primary antidiabetic therapy. Results A total of 1538 patients (769 in each group) were found eligible for study entry. Although the rate of newly diagnosed malignancy, irrespective of specific sites or types, was numerically less frequent in the DPP-4 inhibitors group, the difference in overall cancer risk between groups was not statistically significant (HR=1.00, 95% CI=0.56–1.80, P=0.998). The PS-matched patients were further stratified by relevant patient factors and diabetes severity. No signal of increased risk of malignant complications among DPP-4 inhibitor-receiving diabetic patients was detected in any of the individual strata, nor in the subgroup patients where insulin-exposed patients were excluded from study analyses in consideration of its carcinogenic properties. Patient death or incident pancreatitis events were seldom encountered in both treatment groups; hence such risks were assessed as negligible with the use of either antidiabetic therapy. Conclusion This PS-matched cohort study demonstrated no elevated risk of malignant complications with DPP-4 inhibitor treatment relative to metformin treatment among T2DM patients, irrespective of patient sex, age, comorbid conditions, and diabetes severity status. Similar results were confirmed in the subgroup analyses where a potential confounding effect due to the between-group disparity in insulin co-therapy was eliminated by excluding insulin-exposed patients from risk assessments.
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Affiliation(s)
- Yeo Jin Choi
- Clinical Trial Center, Hallym University Hospital, Anyang, Republic of Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Sooyoung Shin
- Department of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea.,Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, Republic of Korea
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Kwon H, Han KD, Park CY. Weight change is significantly associated with risk of thyroid cancer: A nationwide population-based cohort study. Sci Rep 2019; 9:1546. [PMID: 30733504 PMCID: PMC6367378 DOI: 10.1038/s41598-018-38203-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/20/2018] [Indexed: 12/22/2022] Open
Abstract
Obesity is a risk factor for many cancers including breast, esophageal, colon, and thyroid cancer. We aimed to evaluate the association of thyroid cancer with body mass index (BMI), waist circumference (WC), and weight change. This nationwide population-based cohort study included 11,323,006 adults who joined the national health screening program. Weight change was defined as the difference between the weight of the subjects measured during the study period and the weight at the time of four years ago. For evaluating the association between the weight change and the risk of thyroid cancer, subjects without weight change for four years were defined as the reference group. Mean age was 50.1 ± 13.7 years and 44% were female. In total, 50,464 subjects (0.4%) had newly-diagnosed thyroid cancer. After multivariable analyses, the incidence of thyroid cancer increased significantly in subjects with larger WC as well as higher BMI (P < 0.001 and P < 0.001, respectively). In subjects who were lean and became obese, the incidence of thyroid cancers increased significantly (hazard ratio [HR] 1.15 [1.11-1.19]). In subjects who were obese and became lean, the incidence of thyroid cancers decreased significantly (HR 0.89 [0.86-0.93]). These results demonstrated that higher BMI and larger WC were significantly associated with an increased risk of thyroid cancer. Weight gain in lean subjects was associated with an increased risk of thyroid cancer, and weight reduction in subjects with obesity was associated with a decreased risk of thyroid cancer.
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Affiliation(s)
- Hyemi Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatics, Catholic University College of Medicine, Seoul, Republic of Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Lee YB, Han K, Kim B, Jin SM, Lee SE, Jun JE, Ahn J, Kim G, Kim JH. High Proportion of Adult Cases and Prevalence of Metabolic Syndrome in Type 1 Diabetes Mellitus Population in Korea: A Nationwide Study. Diabetes Metab J 2019; 43:76-89. [PMID: 30302960 PMCID: PMC6387882 DOI: 10.4093/dmj.2018.0048] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/17/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevalence and incidence of type 1 diabetes mellitus (T1DM) in all age groups and the prevalence of metabolic syndrome in patients with T1DM in Korea were estimated. METHODS The incidence and prevalence of T1DM between 2007 and 2013 were calculated using the Korean National Health Insurance Service (NHIS) datasets of claims. Clinical characteristics and prevalence of metabolic syndrome in individuals with T1DM between 2009 and 2013 were determined using the database of NHIS preventive health checkups. RESULTS The prevalence of T1DM in Korea between 2007 and 2013 was 0.041% to 0.047%. The annual incidence rate of T1DM in Korea in 2007 to 2013 was 2.73 to 5.02/100,000 people. Although the incidence rate of typical T1DM was highest in teenagers, it remained steady in adults over 30 years of age. In contrast, the incidence rate of atypical T1DM in 2013 was higher in people aged 40 years or older than in younger age groups. Age- and sex-adjusted prevalence of metabolic syndrome in patients with T1DM was 51.65% to 55.06% between 2009 and 2013. CONCLUSION T1DM may be more common in Korean adults than previously believed. Metabolic syndrome may be a frequent finding in individuals with T1DM in Korea.
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Affiliation(s)
- You Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistic, The Catholic University of Korea, Seoul, Korea
| | - Bongsung Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Sang Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Eun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Eun Jun
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jiyeon Ahn
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.
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Bizuayehu Wube T, Mohammed Nuru M, Tesfaye Anbese A. A Comparative Prevalence Of Metabolic Syndrome Among Type 2 Diabetes Mellitus Patients In Hawassa University Comprehensive Specialized Hospital Using Four Different Diagnostic Criteria. Diabetes Metab Syndr Obes 2019; 12:1877-1887. [PMID: 31571962 PMCID: PMC6756827 DOI: 10.2147/dmso.s221429] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/06/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recognition of MetS in type two diabetic patients is important in starting the appropriate preventive and therapeutic measures. The commonly used definitions of MetS have similarities and discrepancies. Different definitions defined metabolic syndrome differently. IDF, WHO, NCEP-ATP III, and the harmonized definitions were used frequently to determine the prevalence of metabolic syndrome. OBJECTIVES This study was aimed to investigate the prevalence of MetS and its associated factors among patients with type 2 Diabetes Mellitus using four definitions and to identify the concordance and the difference of these four definitions. METHODS A cross-sectional study was conducted from February 28 to May 30/2017 at Hawassa university comprehensive specialized hospital. The study involved 314 study participants selected by simple random sampling technique. Logistic regression was used to determine associated factors of metabolic syndrome, and kappa statistics was used to determine the concordance between different definitions of metabolic syndrome. In any cases, a p-value of <0.05 was considered to be statistically significant. RESULT The prevalence of metabolic syndrome according to IDF, WHO, harmonized, and NCEP-ATP III diagnostic criteria was 59.9%, 31.2%, 65.6%, and 70.1%, respectively. Our study found the maximum agreement between IDF and NCEP criteria (K=0.54, P<0.001) and IDF and Harmonized(K=0.65, P<0.001). Uric acid level was associated factor of metabolic syndrome by all the four definitions, and total cholesterol was associated factors by the three definitions. CONCLUSION The prevalence of metabolic syndrome varies based on the definition used and the highest prevalence of MetS was observed with NCEP-ATP III and the different types of criteria do not always diagnose the same group of individuals.
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Affiliation(s)
- Temesgen Bizuayehu Wube
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Correspondence: Temesgen Bizuayehu Wube School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, P.O. Box:1560, Hawassa, EthiopiaTel +251 916604551 Email
| | | | - Adane Tesfaye Anbese
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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Won JC, Lee JH, Kim JH, Kang ES, Won KC, Kim DJ, Lee MK. Diabetes Fact Sheet in Korea, 2016: An Appraisal of Current Status. Diabetes Metab J 2018; 42:415-424. [PMID: 30113146 PMCID: PMC6202557 DOI: 10.4093/dmj.2018.0017] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/02/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This report presents the recent prevalence and comorbidities related to diabetes in Korea by analyzing the nationally representative data. METHODS Using data from the Korea National Health and Nutrition Examination Survey for 2013 to 2014, the percentages and the total number of subjects over the age of 30 years with diabetes and prediabetes were estimated and applied to the National Population Census in 2014. Diagnosis of diabetes was based on fasting plasma glucose (≥126 mg/dL), current taking of antidiabetic medication, history of previous diabetes, or glycosylated hemoglobin (HbA1c) ≥6.5%. Impaired fasting glucose (IFG) was defined by fasting plasma glucose in the range of 100 to 125 mg/dL among those without diabetes. RESULTS About 4.8 million (13.7%) Korean adults (≥30 years old) had diabetes, and about 8.3 million (24.8%) Korean adults had IFG. However, 29.3% of the subjects with diabetes are not aware of their condition. Of the subjects with diabetes, 48.6% and 54.7% were obese and hypertensive, respectively, and 31.6% had hypercholesterolemia. Although most subjects with diabetes (89.1%) were under medical treatment, and mostly being treated with oral hypoglycemic agents (80.2%), 10.8% have remained untreated. With respect to overall glycemic control, 43.5% reached the target of HbA1c <7%, whereas 23.3% reached the target when the standard was set to HbA1c <6.5%, according to the Korean Diabetes Association guideline. CONCLUSION Diabetes is a major public health threat in Korea, but a significant proportion of adults were not controlling their illness. We need comprehensive approaches to overcome the upcoming diabetes-related disease burden in Korea.
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Affiliation(s)
- Jong Chul Won
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Hyuk Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Chang Won
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
| | - Moon Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Choe SA, Jun YB, Kim SY. Exposure to air pollution during preconceptional and prenatal periods and risk of hypertensive disorders of pregnancy: a retrospective cohort study in Seoul, Korea. BMC Pregnancy Childbirth 2018; 18:340. [PMID: 30134853 PMCID: PMC6106837 DOI: 10.1186/s12884-018-1982-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/15/2018] [Indexed: 01/06/2023] Open
Abstract
Background Previous studies suggested associations between prenatal exposure to air pollution and hypertensive disorders of pregnancy. We explored the associations between ambient concentrations of five major air pollutants during preconceptional and prenatal periods and three hypertensive disorders of pregnancy in Seoul, Korea, using a population-representative cohort. Methods We obtained heath and demographic data of pregnant women residing in Seoul for 2002–2013 from the Korean National Health Insurance Service–National Sample Cohort. For mother’s individual exposures to air pollution, we computed concentrations of particulate matter ≤10 μm in diameter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), and ozone (O3) during 1, 3, 6, and 12 months to birth using regulatory monitoring data in Seoul. The associations between air pollution and hypertensive disorders were explored by using logistic regression models after adjusting for individual confounders. Results Among 18,835 pregnant women in Seoul, 0.6, 0.5, and 0.4% of women developed gestational hypertension, preeclampsia, and preeclampsia requiring magnesium sulfate (Mg-preeclampsia), respectively. Although most odds ratios (ORs) were not statistically significant, we found increasing risk gradients with disease severity depending on the pollutant. There was the association between PM10 during 6 months to birth and gestational hypertension (OR for an interquartile range increase = 1.68 [95% confidence interval = 1.09–2.58]). NO2 and ozone during 12 and 1 month, respectively, before birth were associated with Mg-preeclampsia (1.43 [1.01–2.03], 1.53 [1.03–2.27]). Conclusions We observed positive associations of exposure to some air pollutants before and during pregnancy with hypertensive disorders of pregnancy among the Korean general population. Future studies with refined exposure metrics should confirm our findings. Electronic supplementary material The online version of this article (10.1186/s12884-018-1982-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seung-Ah Choe
- Department of Obstetrics and Gynecology, School of Medicine, CHA University, Gyeonggi-do, Seongnam, 13488, South Korea.,Department of Epidemiology, Brown University School of Public Health, Providence, 02903, RI, USA
| | - Yoon-Bae Jun
- Department of Statistics, Seoul National University, Seoul, 08826, South Korea
| | - Sun-Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Gyeonggi-do, Goyang, 10408, South Korea.
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Metabolic syndrome epidemic among Korean adults: Korean survey of Cardiometabolic Syndrome (2018). Atherosclerosis 2018; 277:47-52. [PMID: 30172084 DOI: 10.1016/j.atherosclerosis.2018.08.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/19/2018] [Accepted: 08/15/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Little information exists on the prevalence of metabolic syndrome (MetS) in Korea since 2007. We aimed to provide up-to-date estimates of the prevalence of MetS and its trend in the general adult population in Korea. METHODS We compared the prevalence and pattern of MetS among participants in the Korean National Health and Nutrition Examination Surveys (KNHANES) IV (2007-2009), V (2010-2012), and VI (2013-2015), aged ≥19 years. Data from the 2005 census of the Korean population were presented according to age standardization. RESULTS The overall age-standardized prevalence of MetS in 2013-2015 was 20.3% (95% confidence interval [CI], 19.6%-21%). Since 2007, the overall prevalence of MetS has remained stable, whereas the prevalences among men and women, respectively, have increased and decreased slightly. By contrast, the prevalence of MetS among men aged 19-49 years has shown an increasing tendency since 2007. Moreover, nearly 40% of women aged ≥60 years had MetS in 2013-2015. Among the five components of MetS, only elevated fasting glucose level has shown an increasing trend since 2007 in both men and women. As the family income and educational level decreased, the prevalence of MetS increased. CONCLUSIONS The overall prevalence of MetS has remained stable since 2007. However, the prevalence of MetS was higher in middle-aged men and women aged ≥60 years. Considering the close association between MetS and socioeconomic status, age- and sex-specific strategies should be developed at the national level for the treatment and prevention of MetS in Korea.
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Noh J. The Effect of Circadian and Sleep Disruptions on Obesity Risk. J Obes Metab Syndr 2018; 27:78-83. [PMID: 31089546 PMCID: PMC6489456 DOI: 10.7570/jomes.2018.27.2.78] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 12/12/2022] Open
Abstract
The prevalence of obesity continues to increase worldwide. Multiple risk factors and complex mechanisms are involved in the development and maintenance of obesity. Recently, emerging evidence has indicated that the circadian rhythm is important for regulating metabolism because the circadian system modulates energy metabolism and enhances certain energetic activities during day and night. Lifestyle also has a great impact on the circadian system. In addition to traditional risk factors, sleep and circadian disruptions are known modifiable risk factors for obesity and other metabolic disorders. This paper reviews recent evidence of relationships between energy metabolism and the circadian system and discusses how sleep disruption and circadian misalignment influence the development of obesity.
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Affiliation(s)
- Junghyun Noh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
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Ko SH, Han K, Lee YH, Noh J, Park CY, Kim DJ, Jung CH, Lee KU, Ko KS. Past and Current Status of Adult Type 2 Diabetes Mellitus Management in Korea: A National Health Insurance Service Database Analysis. Diabetes Metab J 2018; 42:93-100. [PMID: 29676539 PMCID: PMC5911525 DOI: 10.4093/dmj.2018.42.2.93] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/04/2018] [Indexed: 01/21/2023] Open
Abstract
Korea's National Healthcare Program, the National Health Insurance Service (NHIS), a government-affiliated agency under the Korean Ministry of Health and Welfare, covers the entire Korean population. The NHIS supervises all medical services in Korea and establishes a systematic National Health Information database (DB). A health information DB system including all of the claims, medications, death information, and health check-ups, both in the general population and in patients with various diseases, is not common worldwide. On June 9, 2014, the NHIS signed a memorandum of understanding with the Korean Diabetes Association (KDA) to provide limited open access to its DB. By October 31, 2017, seven papers had been published through this collaborative research project. These studies were conducted to investigate the past and current status of type 2 diabetes mellitus and its complications and management in Korea. This review is a brief summary of the collaborative projects between the KDA and the NHIS over the last 3 years. According to the analysis, the national health check-up DB or claim DB were used, and the age category or study period were differentially applied.
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Affiliation(s)
- Seung Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea
| | - Yong Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Cheol Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Up Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Soo Ko
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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Kim GR, Nam CM. Temporal trends in educational inequalities in non-communicable diseases in Korea, 2007-2015. PLoS One 2017; 12:e0190143. [PMID: 29284021 PMCID: PMC5746222 DOI: 10.1371/journal.pone.0190143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/09/2017] [Indexed: 11/19/2022] Open
Abstract
Background Socioeconomic inequalities in non-communicable diseases are known to exist; however there is a paucity of research describing the secular trends in these inequalities. To this end, the current study aims to explore the recent time trends in social patterning of selected non-communicable diseases among Korean adults between 2007 and 2015. Methods Using data from the Korea National Health and Nutrition Examination Survey (KNHANES), temporal trends in socioeconomic inequalities in diabetes, arthritis, asthma and depressive symptoms were assessed across three time points. Respondents were adults aged 20 years or over (N = 47,091, 20,180 men and 26,911 women). Socioeconomic circumstance was assessed based on highest level of educational attainment. We estimated prevalence ratios with 95% confidence intervals using Poisson regression with robust variance estimation (adjusted for age, smoking status, alcohol consumption, obesity, and physical activity) separately for men and women. The magnitude of the inequalities was computed using the relative index of inequality (RII). Results In men, diabetes was not associated with educational attainment, while there was evidence of a negative association in women across surveys. Similar inverse associations were found with arthritis and depressive symptoms, but these associations were less clear for asthma. RII showed a non-significant increasing trend in educational disparities in depressive symptoms. Meanwhile, relative inequalities in diabetes, arthritis and asthma have narrowed. These trends were, in general, more pronounced in women. Conclusions The findings of this study indicate higher burden of selected NCDs among the lower educational groups, particularly among women. In addition, our results indicated some improvements in inequalities in diabetes, arthritis and asthma in recent years. These findings have important implications for understanding the causes of social patterning of NCDs and for the targeting of effective interventions.
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Affiliation(s)
- Gyu Ri Kim
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
- * E-mail:
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Quansah DY, Ha K, Jun S, Kim SA, Shin S, Wie GA, Joung H. Associations of Dietary Antioxidants and Risk of Type 2 Diabetes: Data from the 2007-2012 Korea National Health and Nutrition Examination Survey. Molecules 2017; 22:molecules22101664. [PMID: 28981464 PMCID: PMC6151730 DOI: 10.3390/molecules22101664] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 12/18/2022] Open
Abstract
Antioxidants are suggested to decrease risk of type 2 diabetes (T2D) by preventing progressive impairment of pancreatic β-cell and endothelial function. This study was aimed to investigate the association between dietary antioxidants and risk of T2D in Korean adults based on a national representative data. A total of 24,377 adults (19–74 years) who completed one-day 24 h dietary recall and health examination were included. Dietary antioxidant intakes including α-carotene (p < 0.0001), lycopene (p = 0.0107), flavan-3-ols (p < 0.0001), and proanthocyanidins (p = 0.0075) were significantly higher in non-diabetic subjects than in diabetic subjects. After adjusting for confounding variables, the highest quartile group of α-carotene intake was associated with a 48% reduced risk of T2D in men (OR: 0.52, 95% CI: 0.34–0.80, p for trend = 0.0037) and a 39% reduced risk in women (OR: 0.61, 95% CI: 0.38–0.996, p for trend = 0.0377) compared to the lowest quartile group. Men in the highest quartile of β-carotene intake showed lower risk of T2D (OR: 0.64, 95% CI: 0.42–0.97), but no significant decreasing trend. However, the intakes of total carotenoids and other antioxidants showed no significant association with the risk of T2D. These findings suggest that a further comprehensive approach which considers overall dietary pattern is required.
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Affiliation(s)
- Dan Yedu Quansah
- Graduate School of Public Health, Seoul National University, Seoul 08826, Korea.
| | - Kyungho Ha
- Graduate School of Public Health, Seoul National University, Seoul 08826, Korea.
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA.
| | - Seong-Ah Kim
- Graduate School of Public Health, Seoul National University, Seoul 08826, Korea.
| | - Sangah Shin
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do 17546, Korea.
| | - Gyung-Ah Wie
- Department of Clinical Nutrition, Research Institute & Hospital, National Cancer Center, Goyang 10408, Korea.
| | - Hyojee Joung
- Graduate School of Public Health, Seoul National University, Seoul 08826, Korea.
- Institute of Health and Environment, Seoul National University, Seoul 08826, Korea.
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